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Personal Insurance Checklist

Personal Information
Name*
Email*
Phone*
Address
Street Address Address Line 2 City State ZIP Code
Best Time to Call
Checklist Questions
Do you have collectibles such as antiques, fine art, stamps, coins, or baseball cards?
- Yes
- No
Do you own valuable jewelry or furs?
- Yes
- No
Do you own costly sporting equipment or firearms?
- Yes
- No
Do you have valuable cameras or other photography equipment?
- Yes
- No
Do you have any alarms installed in your home?
- Yes
- No
Describe Alarms
Do you keep more than $100 cash in your home?
- Yes
- No
Are your personal belongings insured for their full replacement value?
- Yes
- No
Do you have children away at college?
- Yes
- No
Do you own tools, equipment, or instruments used in your trade or profession?
- Yes
- No
Do you operate an office or studio in your home?
- Yes
- No
Do clients come into your home to make purchases?
- Yes
- No
Do you baby-sit in your home?
- Yes
- No
Have you recently remodeled or redecorated your home?
- Yes
- No
Do you have plans to remodel or redecorate in the future?
- Yes
- No
If your home suffered an entire loss, would your insurance cover your home's full replacement value?
- Yes
- No
Are you interested in flood insurance for your home and personal property?
- Yes
- No
Are you interested in earthquake coverage?
- Yes
- No
Do you have a wood burning stove?
- Yes
- No
Do you have a swimming pool?
- Yes
- No
Do you own rental or investment property?
- Yes
- No
Do you own a vacation home?
- Yes
- No
If you rent, do you carry renter's insurance?
- Yes
- No
Do you plan to purchase a new vehicle this year?
- Yes
- No
List Potential Vehicles for New Purchase
Would you like us to provide you with an insurance estimate on the vehicle(s) you are considering?
- Yes
- No
Does our agency insure all of your vehicles?
- Yes
- No
Does your automobile policy specify by name all of the drivers in your household?
- Yes
- No
Do you routinely use vehicles you do not own?
- Yes
- No
Do you have non-factory installed equipment, such as car phones, stereos, or CD players in your automobiles?
- Yes
- No
Do you store CD's or cassette tapes in your car?
- Yes
- No
Do you own a vehicle with custom furnishings or equipment?
- Yes
- No
If your vehicle were in an accident, would your current automobile insurance reimburse you for a rental vehicle while yours is being repaired?
- Yes
- No
Do you own any of the following?
- Camper
- Moped
- Golf Cart
- RV/Motor Home
- All-Terrain Vehicle
- Boat or Personal Watercraft
- Other
Other (Please Describe)
Do you carry at least a one-million-dollar umbrella liability policy?
- Yes
- No
Do you own a business?
- Yes
- No
Do we currently insure your business?
- Yes
- No
Do you plan to start a business?
- Yes
- No
Would you like a no-obligation review of your life insurance needs for your business?
- Yes
- No
Do you have sufficient liability or malpractice coverage?
- Yes
- No
Do you and your family have proper health insurance coverage?
- Yes
- No
Do you have disability income insurance?
- Yes
- No
Do other family members need such coverage?
- Yes
- No
Do you have life insurance which pays your mortgage in case of your death?
- Yes
- No
Are you insured for long-term supervised health care?
- Yes
- No
Do you know anyone else who could benefit from a no obligation insurance review from our agency?
- Yes
- No
Refer Your Friends & Family
Name Phone
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Hayden Insurance Agency

1390 Hardy Road
Vinton, Virginia 24179

Phone: (540) 981-0293

Fax: (540) 981-0297

Mon-Fri: 9:00am-5:00pm
Sat-Sun: Closed

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Local Erie Insurance Agent

Hayden Insurance Agency specializes in Auto/Car Insurance, Homeowners Insurance, Business/Commercial Insurance, and Life/Health Insurance to all of Virginia, including Vinton, Roanoke, and Hardy.

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